doccolposcopy 101 - MD Anderson Cancer Center
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colposcopy 101 - MD Anderson Cancer Center
COLPOSCOPY 101 Cervical Cancer Prevention ECHO 2015 Overview of Colposcopy • • • • Background Purpose of Colposcopy Colposcopic findings Case studies Background and History • Colposcopy has been with us since about the 1930’s • Pap smear was only implemented in the 1950’s Purpose of Colposcopy • DETECT Cervical Cancer • Evaluate the abnormal Pap smear • Detect and treat cervical dysplasia How to • • • • • Need Colposcope 5% acetic acid Biospy forceps Kevorkian curet EXPERIENCE !!! Colposcope Instruments When to • LGSIL, HGSIL, AGC and ASC‐H Pap smears all need colposcopy • ASC with high risk HPV needs colposcopy • 2 consecutive ASC Pap smears need colposcopy • Even pregnant patients with abnormal Pap smears can have colposcopy How to Communicate the Findings Colposcopy – satisfactory or unsatisfactory • Sometimes called adequate Description of appearance of lesion: • • • • Acetowhite Mosaicism Punctation Abnormal vessels Satisfactory vs. Unsatisfactory • The entire transformation zone can be visualized • The entire lesion can be visualized Acetic Acid • Acetic acid “stains” metaplastic and dysplastic epithelium • The higher nuclear content of these epithelia blocks the transmission of light to the underlying stroma Use of the Greenfilter • The greenfilter assists in delineating abnormal vasculature • “brings out” the abnormal vessels • Works via selective absorption/reflection of light waves Acetowhite Epithelium • Cervical epithelium appears white with acetic acid • Usually means HPV infection Condyloma • Acetowhite epithelium • Raised, hyperkeratotic area Mosaicism • Tile‐like pattern in a background of acetowhite epithelium • Usually a hallmark of CIN II Punctation • Hairpin capillaries seen on end in a background of acetowhite epithelium • May be coarse or fine • Usually indicative of a high grade lesion Abnormal Vessels • Irregular, non‐branching blood vessels • Abrupt changes in direction • Usually indicative of at least a high grade lesion vs. early cancer How to Put it All Together • • • • • Abnormal Papsmear Colposcopy Recognize the patterns Take biopsies and do ECC if necessary Treat appropriately
